Abt Associates Inc. proposes a two-year project to develop and implement an ongoing Rx Drug Diversion Surveillance Program that will provide epidemiological data at the national and sub-national levels for 2008. The principal aim will be to estimate the diversion from retail pharmacies of 25 different controlled prescription drugs, most of which are scheduled and are known to be abused. Estimates will be developed of the numbers of individuals diverting these drugs for non-medical use, the numbers of prescriptions involved, the amounts of drugs so diverted (measured in dosage units and, separately, days supply), and the proportions of all dispensed prescriptions of each specific drug that are diverted. Combining these estimates with population data from U.S. census, prevalence rates (per 100,000 residents) will be developed for each of the 25 drugs at several levels: national, regional, state, county, town/city and, where meaningful, at the sub- city level. Estimates will also be developed for other geographical areas, such as rural/urban/suburban areas and largest 20 metropolitan areas. Socio-economic data from the 2000 U.S. census will be used to characterize the populations in these various geographical areas, and the relationships among prevalence rates and these contextual characteristics will be examined. This will provide a means for fine-grained analyses of the prevalence of prescription drug diversion in various areas of the nation and in various population subgroups. The study will exploit proprietary datasets developed for market research purposes, which are unique because information about prescriptions dispensed, patients, pharmacies, and prescribing physicians have been linked by means of HIPAA-compliant procedures. Computer algorithms will be developed to mine these data in search of suspicious patterns-combinations of patient/prescriber/prescription/pharmacy characteristics-indicative of diversion. Prevalence estimates so derived will be compared to estimates of drug use reported in other surveys and monitoring programs. In addition to developing estimates for 2008, the project will lay the foundation for an ongoing surveillance program (which will require separate funding). Patient-linked data are available back to 2001 and could be added subsequently. Going forward, prevalence estimates could be developed on an annual basis with continuously augmented data, and the program could be expanded to include other prescription drugs. This platform would therefore provide the scientific community with a rich dataset and powerful analytic tools to study diversion and misuse of prescription drugs throughout the nation and over time. PUBLIC HEALTH RELEVANCE: This two-year study and the ongoing surveillance program will support improvements in public health and health care delivery. Public investments in treatment capacity depend in part upon accurate estimation of trends in substance misuse at local levels, and more accurate estimates of diverted prescription drugs in these local illicit markets may improve these resource allocation decisions.